Free-Living User Perspectives on Musculoskeletal Pain and Patient-Reported Mobility With Passive and Powered Prosthetic Ankle-Foot Components: A Pragmatic, Exploratory Cross-Sectional Study

A systematic review of energy storing dynamic response foot for prosthetic rehabilitation

The purpose of this paper is to undertake a systematic review on various mechanical design considerations, simulation and optimization techniques as well as the clinical applications of energy storing and return (ESAR) prosthetic feet used in amputee rehabilitation. Methodological databases including PubMed, EMBASE, and SCOPUS were searched till July 2022, and the retrieved records were evaluated for relevance. The design, mechanism, materials used, mechanical and simulation techniques and clinical applications of ESAR foot used in developed and developing nations were reviewed. 61 articles met the inclusion criteria out of total 577 studies. A wide variety of design matrices for energy- storing feet was found, but the clinical relevance of its design parameters is uncommon. Definitive factors on technical and clinical characteristics were derived and included in the summary tables. To modify existing foot failure mechanisms, material selection and multiple experiments must be improved. Gait analysis and International Organization for Standardization (ISO) mechanical testing standards of energy-storing feet were the methods for integrating clinical experimentation with numerical results. To meet technological requirements, various frameworks simulate finite element models of the energy-storing foot, whereas clinical investigations involving gait analysis require proper insight. Analysis of structural behavior under varying loads and its effect on studies of functional gait are limited. For optimal functional performance, durability and affordability, more research and technological advancements are required to characterize materials and standardize prosthetic foot protocols.

Gait quality in prosthesis users is reflected by force-based metrics when learning to walk on a new research-grade powered prosthesis

Introduction

Powered prosthetic feet require customized tuning to ensure comfort and long-term success for the user, but tuning in both clinical and research settings is subjective, time intensive, and the standard for tuning can vary depending on the patient's and the prosthetist's experience levels.

Methods

Therefore, we studied eight different metrics of gait quality associated with use of a research-grade powered prosthetic foot in seven individuals with transtibial amputation during treadmill walking. We compared clinically tuned and untuned conditions with the goal of identifying performance-based metrics capable of distinguishing between good (as determined by a clinician) from poor gait quality.

Results

Differences between the tuned and untuned conditions were reflected in ankle power, both the vertical and anterior-posterior impulse symmetry indices, limb-force alignment, and positive ankle work, with improvements seen in all metrics during use of the tuned prosthesis.

Discussion

Notably, all of these metrics relate to the timing of force generation during walking which is information not directly accessible to a prosthetist during a typical tuning process. This work indicates that relevant, real-time biomechanical data provided to the prosthetist through the future provision of wearable sensors may enhance and improve future clinical tuning procedures associated with powered prostheses as well as their long-term outcomes.